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  • Daskalakis, Kosmas,1979-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Second Department of Surgery, "Korgialenio-Benakio", Red Cross General Hospital, Athens, Greece (author)

Association of lymph node metastases, grade and extent of mesenteric lymph node dissection in locoregional small intestinal neuroendocrine tumors with recurrence-free survival

  • Article/chapterEnglish2022

Publisher, publication year, extent ...

  • 2022-11-17
  • Wiley-Blackwell Publishing Inc.2022
  • printrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:oru-102266
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-102266URI
  • https://doi.org/10.1111/jne.13205DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • We aimed to assess the prognostic impact of tumor- and patient-related parameters in patients with stage I-III small intestinal neuroendocrine tumors (SI-NETs), who underwent locoregional resective surgery (LRS) with curative intent. We included 229 patients with stage I-III SI-NETs diagnosed from June 15, 1993, through March 8, 2021, identified using the SI-NET databases from five European referral centers. Mean ± SD age at baseline was 62.5 ± 13.6 years; 111/229 patients were women (49.3%). All tumors were well-differentiated; 160 were grade 1 (G1) tumors, 51 were G2, two were G3 and 18 tumors were of unspecified grade (median Ki-67: 2%, range 1%-50%). One-hundred and sixty-three patients (71.2%) had lymph node (LN) involvement. The median number of retrieved lymph nodes was 10 (0-63), whereas the median number of positive LNs was 2 (0-43). After a mean ± SD follow-up of 54.1 ± 64.1 months, 60 patients experienced disease recurrence at a median (range) of 36.2 (2.5-285.1) months. The 5- and 10-year recurrence-free survival (RFS) rates were 66.6% and 49.3% respectively. In univariable analysis, there was no difference in RFS and overall survival (OS) between LN-positive and LN-negative patients (log-rank, p = .380 and .198, respectively). However, in stage IIIb patients who underwent mesenteric lymph node dissection (MLND) with a minimum of five retrieved LN (n = 125), five or more LN metastases were associated with shorter RFS (median RFS [95% CI] = 107.4 [0-229.6] vs. 73.7 [35.3-112.1] months; log-rank, p = .048). In addition, patients with G2 tumors exhibited shorter RFS compared to patients with G1 tumors (median RFS [95% confidence interval (CI)] = 46.9 [36.4-57.3] vs. 120.7 [82.7-158.8] months; log-rank, p = .001). In multivariable Cox-regression RFS analysis in stage IIIb patients, the Ki-67 proliferation index (hazard ratio = 1.08, 95% CI = 1.035-1.131; p < .0001) and the number of LN metastases (hazard ratio = 1.06, 95% CI = 1.001-1.125; p = .047) were independent prognostic factors for RFS. In conclusion, LRS with a meticulous MLND and a minimum number of five harvested LNs appears to be critical in the surgical management of SI-NET patients with locoregional disease. In patients who underwent LRS and MLND, the Ki-67 proliferation index and the LN metastases count were independent predictors of RFS.

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  • Wedin, Maria,1977-Örebro universitet,Institutionen för medicinska vetenskaper,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden(Swepub:oru)mrwn (author)
  • Tsoli, MarinaEndocrine Oncology Unit, First Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece (author)
  • Kogut, AngelikaDepartment of Endocrinology and Neuroendocrine Neoplasms, Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland (author)
  • Srirajaskanthan, RajENETS Centre of Excellence, Neuroendocrine Tumour Unit, King's College Hospital, London, UK; Department of Gastroenterology, King's College Hospital, London, UK (author)
  • Sarras, KonstantinosDepartment of Gastroenterology, King's College Hospital, London, UK (author)
  • Kattiparambil, SajithDepartment of Gastroenterology, King's College Hospital, London, UK (author)
  • Giovos, GeorgeThe ARDEN NET Centre, European Neuroendocrine Tumour Society (ENETS) Centre of Excellence (CoE), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK (author)
  • Weickert, Martin O.The ARDEN NET Centre, European Neuroendocrine Tumour Society (ENETS) Centre of Excellence (CoE), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK (author)
  • Kos-Kudla, BeataDepartment of Endocrinology and Neuroendocrine Neoplasms, Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland (author)
  • Kaltsas, GregoryEndocrine Oncology Unit, First Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece (author)
  • Örebro universitetInstitutionen för medicinska vetenskaper (creator_code:org_t)

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  • In:Journal of neuroendocrinology: Wiley-Blackwell Publishing Inc.34:110953-81941365-2826

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